Healthcare Provider Details

I. General information

NPI: 1134614514
Provider Name (Legal Business Name): KOREY TAYLOR HURLEY DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2018
Last Update Date: 06/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6030 PARK BLVD N
PINELLAS PARK FL
33781-3228
US

IV. Provider business mailing address

151 7TH ST S UNIT 702
ST PETERSBURG FL
33701-4082
US

V. Phone/Fax

Practice location:
  • Phone: 727-547-6453
  • Fax:
Mailing address:
  • Phone: 727-542-1500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN23537
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: